30 research outputs found
Primary multifocal osseous Hodgkin's lymphoma
BackgroundHodgkin's disease (HD) most commonly presents with progressive painless enlargement of peripheral lymph nodes, especially around the cervical region. A few children have systemic symptoms and weight loss. At the time of diagnosis, osseous involvement is uncommonCase presentationA case is described of Primary Multifocal Osseous Hodgkin's Lymphoma in a seven-year-old boy. He presented with a painful swelling in the sternum, and further investigations revealed deposits in his L1 vertebra, the left sacro-iliac joint and the right acetabulum.ConclusionThe clinical, radiological and histological features of this disease can mimic other medical conditions, including Tuberculosis, making the diagnosis difficult and often leading to delays in treatment. This is a very rare condition and we believe this to be the youngest reported case in the literature
Toxicity and patient-reported outcomes of a phase 2 randomized trial of prostate and pelvic lymph node versus prostate only radiotherapy in advanced localised prostate cancer (PIVOTAL)
Purpose
To establish the toxicity profile of high-dose pelvic lymph node intensity-modulated radiation therapy (IMRT) and to assess whether it is safely deliverable at multiple centers.
Methods and Materials
In this phase 2 noncomparative multicenter trial, 124 patients with locally advanced, high-risk prostate cancer were randomized between prostate-only IMRT (PO) (74 Gy/37 fractions) and prostate and pelvic lymph node IMRT (P&P; 74 Gy/37 fractions to prostate, 60 Gy/37 fractions to pelvis). The primary endpoint was acute lower gastrointestinal (GI) Radiation Therapy Oncology Group (RTOG) toxicity at week 18, aiming to exclude a grade 2 or greater (G2+) toxicity-free rate of 80% in the P&P group. Key secondary endpoints included patient-reported outcomes and late toxicity.
Results
One hundred twenty-four participants were randomized (62 PO, 62 P&P) from May 2011 to March 2013. Median follow-up was 37.6 months (interquartile range [IQR], 35.4-38.9 months). Participants had a median age of 69 years (IQR, 64-74 years) and median diagnostic prostate-specific androgen level of 21.6 ng/mL (IQR, 11.8-35.1 ng/mL). At week 18, G2+ lower GI toxicity-free rates were 59 of 61 (96.7%; 90% confidence interval [CI], 90.0-99.4) for the PO group and 59 of 62 (95.2%; 90% CI, 88.0-98.7) for the P&P group. Patients in both groups reported similarly low Inflammatory Bowel Disease Questionnaire symptoms and Vaizey incontinence scores. The largest difference occurred at week 6 with 4 of 61 (7%) and 16 of 61 (26%) PO and P&P patients, respectively, experiencing G2+ toxicity. At 2 years, the cumulative proportion of RTOG G2+ GI toxicity was 16.9% (95% CI, 8.9%-30.9%) for the PO group and 24.0% (95% CI, 8.4%-57.9%) for the P&P group; in addition, RTOG G2+ bladder toxicity was 5.1% (95% CI, 1.7%-14.9%) for the PO group and 5.6% (95% CI, 1.8%-16.7%) for the P&P group.
Conclusions
PIVOTAL demonstrated that high-dose pelvic lymph node IMRT can be delivered at multiple centers with a modest side effect profile. Although safety data from the present study are encouraging, the impact of P&P IMRT on disease control remains to be established
Optimal resolution tomography with error tracking and the structure of the crust and upper mantle beneath Ireland and Britain
The classical BackusâGilbert method seeks localized Earth-structure averages at the shortest
length scales possible, given a data set, data errors, and a threshold for acceptable model
errors. The resolving length at a point is the width of the local averaging kernel, and the
optimal averaging kernel is the narrowest one such that the model error is below a specified
level. This approach is well suited for seismic tomography, which maps 3-D Earth structure
using large sets of seismic measurements. The continual measurement-error decreases and
data-redundancy increases have reduced the impact of random errors on tomographic models.
Systematic errors, however, are resistant to data redundancy and their effect on the model is
difficult to predict. Here, we develop a method for finding the optimal resolving length at every
point, implementing it for surface-wave tomography. As in the BackusâGilbert method, every
solution at a point results from an entire-system inversion, and the model error is reduced by
increasing the model-parameter averaging. The key advantage of our method stems from its
direct, empirical evaluation of the posterior model error at a point. We first measure inter-
station phase velocities at simultaneously recording station pairs and compute phase-velocity
maps at densely, logarithmically spaced periods. Numerous versions of the maps with varying
smoothness are then computed, ranging from very rough to very smooth. Phase-velocity curves
extracted from the maps at every point can be inverted for shear-velocity (V S ) profiles. As
we show, errors in these phase-velocity curves increase nearly monotonically with the map
roughness. We evaluate the error by isolating the roughness of the phase-velocity curve that
cannot be explained by any Earth structure and determine the optimal resolving length at a point
such that the error of the local phase-velocity curve is below a threshold. A 3-D V S model is then
computed by the inversion of the composite phase-velocity maps with an optimal resolution
at every point. The estimated optimal resolution shows smooth lateral variations, confirming
the robustness of the procedure. Importantly, the optimal resolving length does not scale with
the density of the data coverage: some of the best-sampled locations display relatively low
lateral resolution, probably due to systematic errors in the data. We apply the method to image
the lithosphere and underlying mantle beneath Ireland and Britain. Our very large data set
was created using new data from Ireland Array, the Irish National Seismic Network, the UK
Seismograph Network and other deployments. A total of 11 238 inter-station dispersion curves,
spanning a very broad total period range (4â500 s), yield unprecedented data coverage of the
area and provide fine regional resolution from the crust to the deep asthenosphere. The lateral
resolution of the 3-D model is computed explicitly and varies from 39 km in central Ireland to
over 800 km at the edges of the area, where the data coverage declines. Our tomography reveals
pronounced, previously unknown variations in the lithospheric thickness beneath Ireland and Britain, with implications for their Caledonian assembly and for the mechanisms of the British
Tertiary Igneous Province magmatism
Overshadowing depends on cue and reinforcement sensitivity but not schizotypy
There is evidence for impaired selective learning mechanisms in individuals high in schizotypy. Overshadowing provides a direct test of selective learning based on cue salience and has previously been reported to be impaired in relation to schizotypy scores. The present study tested for overshadowing using food allergy and Lego construction task variants. Both variants used the same number of conditioned stimulus (CS) cues and the same number of learning trials. CS cues were trained in compound pairs or in isolation and overshadowing was subsequently tested on trials followed by negative versus positive outcomes. Participants also completed the O-LIFE to measure schizotypy and BIS-BAS scales to measure reinforcement sensitivity. Learning was demonstrated for both cue variants; however overshadowing emerged only in the Lego variant and only on the trials followed by the negative outcome. Contrary to expectations, there was no evidence for any relationship between overshadowing and O-LIFE scores. However, there was evidence of a positive relationship between overshadowing and BAS-Drive as well as a negative relationship with BIS-Anxiety, for the trials followed by the positive outcome in the food allergy variant. These results suggest that the development of overshadowing depends on cue and reinforcement sensitivity, but not necessarily on schizotypy
Neonatal infections: Case definition and guidelines for data collection, analysis, and presentation of immunisation safety data.
Maternal vaccination is an important area of research and requires appropriate and internationally comparable definitions and safety standards. The GAIA group, part of the Brighton Collaboration was created with the mandate of proposing standardised definitions applicable to maternal vaccine research. This study proposes international definitions for neonatal infections. The neonatal infections GAIA working group performed a literature review using Medline, EMBASE and the Cochrane collaboration and collected definitions in use in neonatal and public health networks. The common criteria derived from the extensive search formed the basis for a consensus process that resulted in three separate definitions for neonatal blood stream infections (BSI), meningitis and lower respiratory tract infections (LRTI). For each definition three levels of evidence are proposed to ensure the applicability of the definitions to different settings. Recommendations about data collection, analysis and presentation are presented and harmonized with the Brighton Collaboration and GAIA format and other existing international standards for study reporting
Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial
Background
Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy